8th time’s a charm.

At least for pancreatic cancer staging. Unlike for skin cancer, this international validation of the AJCC 8th ed staging demonstrates much clearer separation of survival curves than with 7th ed staging among >1500 patients with resected pancreatic cancer. We often focus on resectability of the primary tumor, but that doesn’t tell the whole story. Over half of these resected patients were re-staged using 8th ed criteria, with the vast majority of these being upstaged thanks to changes in nodal staging. As a reminder, the only real change in the 8th ed occurred with a split of N1 (any involved nodes per 7th ed) into N1 (1-3 involved nodes) and N2 (≥4 involved nodes).  Rates of overall survival at 5 years were 36% with N0, 21% with N1, and 11% with N2. TBL: Number of nodes involved on path review of resected pancreatic cancer is highly predictive of survival. | van Roessel, JAMA Surg 2018